Provider Demographics
NPI:1437207024
Name:XU, ZHI XIN (MD)
Entity type:Individual
Prefix:DR
First Name:ZHI
Middle Name:XIN
Last Name:XU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4746 190TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3831
Mailing Address - Country:US
Mailing Address - Phone:718-961-9025
Mailing Address - Fax:718-961-9026
Practice Address - Street 1:3907 PRINCE ST
Practice Address - Street 2:SUITE 3J
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5399
Practice Address - Country:US
Practice Address - Phone:718-961-9025
Practice Address - Fax:718-961-9026
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225000208000000X
CT040344208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02300961Medicaid
NYW08221Medicare ID - Type Unspecified
NYH74674Medicare UPIN